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AND 

SYSTEM I OB 1 ETH ICS | J|l 

OF THE 

Medical Association 

OF THE 

DISTRICT OF COLUMBIA. 



May, 1899. 



WASHINGTON, D. C. :. v • 

H. L. McQueen, Printer and Publisher. 



OF MEDICINE NATIONAL LIBRARY OF MEDICINE 




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IY OF MEDICINE NATIONAL LIBRARY OF MEDICINE 



REGULATIONS ^ 



AND 



SYSTEM OF ETHICS 



Medical Association 



OF THE 



DISTRICT OF COLUMBIA. 



May, 1899. 



H. L. 



washington, d. c. '. 
McQueen, Printer and Publisher. 
1899. 



Sfr • 
/??? 

C./ 

NATIONAL LlBKAKf OF iVitJiwrtt 
WASHINGTON, D. & 

OFFICERS OF THE MEDICAL ASSOCIATION, 

1899. 



D. WEBSTER PRENTISS, M. D. . . . President. 

t. n. Mclaughlin, m. d. ) „ _ . . . 

_ . _ . . i > v . vicc-Presidcnts. 

E. A. BALLOCH, M. D. j 

J. R. WELLINGTON, M. D Secretary. 

FRANK LEECH, M. D Treasurer. 

COUNSELORS — Standing Committee. 

H. L. E. JOHNSON, M. D., Chairman. 
GEORGE N. ACKER, M. D. 
WILLIAM P. CARR, M. D. 
R. T. HOLDEN, M. D. 
D. OLIN LEECH, M. D. 

CENSORS. 

WILLIAM C. WOODWARD, M. D. G. WYTHE COOK, M. D. 

LARKIN W. GLAZEBROOK, M. D. 



CLIFTON MAYFIELD, M. D. 
JOHN S. McLAIN, M. D. 
GEORGE C. OBER, M. D. 
T. R. STONE, M. D. 



EX-PRESIDENTS. 

Frederick May, M. D Elected 

Alexander McWilliams, M. D " 

William Jones, M. D " 

Joshua Riley, M. D " 

Noble Young, M. D " 

J. W. H. Lovejoy, M. D 

Thomas Miller, M. D " 

F. Howard, M. D " 

S. C. Busey, M. D 

Louis Mackall, M. D . " 

James E. Morgan, M. D " 

Johnson Eliot, M. D " 

J. Ford Thompson, M. D " 

A. Y. P. Garnett, M. D 

D. R. Hagner, M. D 

Joseph Burrows, M. D " 

D. C. Patterson, M. D 

J. M. Toner, M. D « 

J. W. Bulkley, M. D 

W. W. Johnston, M. D " 

James T. Young, M. D " 

J. 0. Stanton, M. D •< 

C. W. Franzoni, M. D 

N. S. Lincoln, M. D " 

Llewellyn Eliot, M. D " 

George B. Harrison, M. D « 

C. H. A. Kleinschmidt, M. D " 

William P. Carr, M. D 

G. Wythe Cook, M. D 

Geo. M. Kober, M. D " 

D. Webster Prentiss, M. D " 



January, 1833. 



February 8, 1847. 


May 7, 1850. 


May 13, 


1858. 


April 7, 


1868. 


April 5, 


1870. 


April 1, 


1873. 


October 7, 1873. 


April 6, 


1875. 


April 4, 


1876. 


April 1, 


1879. 


April 6, 


1880. 


April 5, 


1881. 


April 4, 


1882. 


April 3, 


1883. 


April 1, 


1884. 


April 7, 


1885. 


April 6, 


1886. 


April 5, 


1887. 


April 3, 


1888. 


April 2, 


1889. 


April 1, 


1890. 


April 7, 


1891. 


April 5, 


1892. 


April 4, 


1893. 


April 3, 


1894. 


April 2, 


1895. 


April 7, 


1896. 


April 6, 


1897. 


April 5, 


1898. 


April 4, 


1899. 



Regulations and System of Ethics of the 
Medical Association of the District 
of Columbia. 



ADOPTED MAY 9, 1899. 



REGULATIONS. 

Article I. 
Name. 

This Association shall be known as the Medical Asso- 
ciation of the District of Columbia. 

Article II. 
Ethics. 

The code of ethics of the American Medical Association 
shall be the code of ethics of this Association, and its re- 
quirements shall be binding upon the members. 

Article III. 
Membership. 

Section 1. The membership of this Association shall 
be limited to legally qualified regular practitioners of 
medicine residing in the District of Columbia and who 
are engaged in no other occupation. 

Sec. 2. Should any one elected to membership subse- 
quently accept a government clerkship or engage in any 
business or occupation not connected with the regular 
practice of medicine, his connection with this Association 
shall cease immediately. 

Sec. 3. The existing Associate members shall be enti- 
tled to consultations, but to no other privilege of the 
Association. 



4 



Article IV. 
Applications for Membership. 
All applications for membership shall be made 
on blank forms adopted by the Association, and ad- 
dressed to the Secretary, who shall read them, at the first 
stated meeting following their reception, and immediate!}' 
forward the same to the Board of Censors, for their investi- 
gation, for report at the next stated meeting. 

Article V. 
Officers. 

The Officers of this Association shall be a President, 
two Vice-Presidents, a Secretary, a Treasurer, nine 
Counselors and three Censors. 

Article VI. 
Duty of Officers. 
Section 1. The President shall preside at all meetings of 
the Association. He shall call special meetings when re- 
quested in writing, by the Standing Committee, or any 
three members of the Association. He shall appoint all 
special committees, unless otherwise ordered by the 
Association, and an auditing committee to audit the 
accounts of the Treasurer. He shall sign all con- 
tracts and indorse all vouchers when authorized by the 
Association. During his absence one of the Vice-Presi- 
dents shall perform the duties of the President; and in 
the absence of these officers a temporary chairman shall 
be chosen from the members present. 

Duties of the Secretary. 
Sec. 2. (a) The Secretary shall keep a record of the 
proceedings and conduct all correspondence of the As- 
sociation. He shall give notice, by order of the Presi- 
dent, of all stated and special meetings by postal-card or 
circular, to each member, at least four days previous to 
the meetings; notify officers and members of their elec- 



5 



tion, calling special attention of the latter to the neces- 
sity of their signing the regulations as provided in Ar- 
ticle VII, Sec. 2. He shall furnish to each member a 
printed list of applicants for membership two weeks 
prior to the stated meeting, at which their applications 
are to be voted upon ; he shall notify members of their 
election, by the Association or the Standing Committee, 
as delegates to the American Medical Association, and 
direct them to notify him within ten days of their ac- 
ceptance or non-acceptance. He shall, in case a delegate 
is unable to serve, or fails to accept within the time 
specified, notify the Standing Committee of such fact. 
He shall issue a credential to each delegate who accepts 
as herein required, but to none other. He shall furnish 
annually, on or about May 1st, to each member a printed 
roster of the Officers and Members of the Association, 
with their addresses. 

(6) At the stated meetings he shall read all applica- 
tions for membership, and forward them promptly to the 
Board of Censors, keeping a record of the same. He 
shall immediately notify each member of the Associa- 
tion by circular note whenever a member is dropped for 
non-payment of dues, or expelled from the Association. 
Duties of the Treasurer. 

Sec. 3. The Treasurer shall have charge of the funds, 
collect all assessments, and disburse the same by direc- 
tion of the Association, on vouchers indorsed by the 
President. He shall render at each stated meeting an 
account of the funds received, with the vouchers for his 
disbursements, which shall be audited semi-annually by a 
Committee, appointed by the President, He shall 
promptly report all delinquent members to the Secre- 
tary. 

Duties of the Counselors. 
Sec. 4. (a) The Counselors shall constitute a Standing 



6 



Committee to consider and decide all matters which con- 
cern the honor and interest of the Association ; they 
shall make such rules for their guidance as they may 
deem proper, and shall select a chairman and secretary 
from their number. They shall request the President, in 
writing, to call special meetings of the Association when- 
ever they consider it necessary. 

(b) They shall investigate all infringements or viola- 
tions of the ethics of the Association which may come 
to their knowledge, but investigations of alleged viola- 
tions shall be made only upon written charges, submitted 
to this Committee by one or more members of the Asso- 
ciation. The charges must be specific, giving the name 
of the offending party or parties and of those cognizant 
of the alleged facts. The committee shall then proceed 
to investigate the accusation and collect the testimony of 
the witnesses whose names have been furnished, and such 
other information as may be deemed necessary. 

(c) The Committee shall have authority to summon 
and examine members, and in the event of their failure 
or refusal to appear or to give evidence, the Committee 
shall report such failure or refusal, to the Association, for 
such action as that body may deem just and proper. 

(d) Should the Standing Committee, by vote of two- 
thirds, find any member or members guilty of a viola- 
tion of the regulations and ethics, they shall request the 
President to call, immediately, a special meeting of the 
Association, to which they shall report their decision with 
the facts and evidence adduced, all of which shall be read 
in open meeting. Should their decision be confirmed 
by a two-thirds vote of the members present, at an ad- 
journed meeting, which shall be held within ten days 
thereafter, the member or members found guilty shall, 
on motion, receive such punishment as may be deter- 
mined by a two-thirds vote of the members present. 



(e) The Standing Committee shall have power to ad- 
just minor complaints and differences between members, 
without reporting to the Association, but in all such 
cases an appeal may be made to the Association from the 
decision of the Committee, by one or more of the parties 
concerned. 

(/) The Standing Committee shall assess equally upon 
all the members, the amount required for the contingent 
expenses of the Association, but the amount of such as- 
sessment, in no one year, shall exceed the sum of two 
dollars. 

(g) The Standing Committee shall fill all vacancies 
occurring among the delegates to the American Medical 
Association and promptly certify to the Secretary of this 
Association the names of those so elected. 

(h) The Standing Committee shall keep full records of 
its proceedings, and shall submit the same to the Asso- 
ciation, at any meeting, if directed to do so by a ma- 
jority of the members present. 

(i) Meetings of this Committee shall be called at the 
discretion of its chairman or when he is requested to do 
so by two of its members. 

Duties of the Board of Censors. 
Sec. 5. The Censors shall inquire into the qualifications 
of all applicants for membership and report to the Asso- 
ciation, at a stated meeting, the results of their investi- 
gations. 

Article VII. 
Elections. 

Section 1. The Officers of this Association shall be 
elected by ballot at the stated meeting in April of each 
year, by a majority of the members present, but any 
vacancy shall be filled at the first meeting following 
its occurrence. 

Sec. 2. Applicants for membership shall be proposed 



8 



at one stated meeting and voted on by ballot at the next 
stated meeting, after they have been reported upon by 
the Board of Censors, and upon a favorable vote of two- 
thirds of the members present, the applicants shall be 
admitted to membership; Provided, They sign the obliga- 
tion of the regulations and system of ethics within thirty 
days thereafter. 

Sec. 3. The delegates to the American Medical Asso- 
ciation shall be nominated and elected at the stated 
meeting in April, or at an adjourned meeting held with- 
in ten days thereafter. The delegates elected shall sig- 
nify in writing to the Secretary of this Association, with- 
in ten days, their acceptance and their determination to 
serve. 

Sec. 4. In case of declination or failure of delegates to 
accept, the Secretary shall notif}' the Standing Committee, 
and thereupon the said Committee shall fill such vacancies 
and certify to the Secretary the names of those selected. 

Article VIII. 
Quorum. 

Section 1. Twenty members shall constitute a quorum 
at any stated, adjourned or special meeting of the Asso- 
ciation. 

Sec. 2. Five members shall constitute a quorum at 
any meeting of the Standing Committee. 

Sec. 3. A majority of its members shall constitute a 
quorum at the meeting of any special committee. 

Article IX. 
Meetings — Stated and Special. 
Section 1. This Association shall hold stated meetings 
on the first Tuesdays of April and October of each year, at 
8 o'clock p. m., at such place within the District of Colum- 
bia as may be designated by the President or by vote of 
the Association. 



11 



Sec. 2. Special meetings shall be called by the President 
when requested in writing by the Standing Committee or 
any three members of the Association. 

Article X. 
Order of Business. 

1. Call to Order. 

2. Reading of minutes of the previous meeting. 

3. Unfinished business. 

4. Report of Censors, and Election of Applicants for 

membership. At stated meetings. 

5. Report of Treasurer at stated meetings. 

6. Reports of Committees. 

7. Election of Officers and of Delegates to the Ameri- 

can Medical Association at the stated meeting in 
April. 

8. Miscellaneous Business. 

9. Adjournment. 

Article XL 
Duties of Members. 

Section 1. It shall be the duty of every member who be- 
comes acquainted with any breach of the regulations 
and ethics of this Association, to make the fact known to 
the Standing Committee, who shall inquire into the same. 

Sec. 2. In certificates of illness concerning absence 
from official duties given to employees in the public serv- 
ice, or others, the disease shall not be specified, neither 
shall the name or nature of the disease be divulged by 
any written description or statement of symptoms, given 
to the patient, nor by any specification of the disorder, 
nor by any disclosure which may be construed as an eva- 
sion of the purpose of this regulation. 

Sec. 3. It shall be the duty of members of this Associa- 
tion to discourage patients from defrauding other mem- 
bers, and it is expected that the members will use all just 



10 



and proper means to assist eacli other in the collection of 
their fees for professional services. 

Sec. 4. No member of this Association shall consult in 
private or hospital practice, with any resident practitioner 
in this District who is not a member thereof, or whose 
application for membership has not been filed with the 
Secretary, or who has been dropped from membership, or 
declined admission ; but this regulation shall not apply to 
medical officers of the Army, Navy or Marine Hos- 
pital Service of the United States, or to Associate mem- 
bers, or to legalized practitioners of African descent, or 
to legalized practitioners from other States, who may be 
called to attend cases in this District, provided their 
practice conforms to the ethics of the American Medical 
Association. 

Sec. 5. While the privilege of selecting the consulting 
physician is conceded to the patient or his immediate 
fam\\y, nevertheless, as the good of the patient is the sole 
object in view, it shall be allowable for the attending 
physician to express his preference. 

Sec. 6. No member of this Association who has been 
called in as consulting physician, in a medical or surgical 
case, shall assume sole charge of the patient, during the 
same illness, unless he shall have been specifically re- 
quested to do so by the attending physician. 



Section .1. The following fees shall be charged for 
professional services, subject, however, to the several 
rules which are appended: 



Article XII. 
Fees and Rules Governing. 



First visit 

Each subsequent visit . 
Office consultation . . 
Each consultation visit 



$2 to $10 

2 " 10 

2 " io 

5 " 25 



11 



The attending physician is entitled for each meet- 
ing to $5 to $25 

Visit at night (night is understood to commence at 

8 p. m. and end at 8 a. m.) 5 " 25 

Passing catheter or bougie 5 " 15 

Advice at night at physician's house 5 " 10 

Visiting at an hour specified by the patient, the 

usual consultation fee. 
Visiting out of the city, at the discretion of the phy- 
sician. 

For services to distant patients, in addition to ex- 
penses of travel, per day 50 " 500 

Detention in any case at patient's house .... 5 " 100 
All cases of small-pox, diphtheria and scarlet fever, 

for each visit 3 " 10 

Case of gonorrhoea, each consultation (cash) .... 5 " 15 
Case of syphilis, each consultation (cash) .... 5 " 25 

Venesection 10 " 25 

Microscopic examination 5 " 100 

Examination of urine 5 " 25 

Cases of obstetrics 25 " 500 

Operations for Cesarean Section, Symphyseotomy- 
Extra-uterine pregnancy, High forceps, Version, 

Induction of premature labor 100 " 1,000 

All obstetrical services cash. 

Operation for lacerated perineum 50 " 300 

Operation for lacerated cervix uteri 50 " 300 

Operation for removal of uterine tumors 100 " 1,000 

Operation for vesico-vaginal or recto- vaginal fistula, 100 " 500 

Ovariotomy or Hysterectomy 100 " 1,000 

Dilating or curetting uterus 50 " 100 

Operation for appendicitis 100 " 1,000 

Capital operation, as, for example, amputating large 
limbs, lithotomy, trepanning, excision of large 
tumors, operation for radical cure of hernia, for 
aneurism, extirpation of cancerous breast, ligation 

of large arteries, etc 100 " 1,000 

Abdominal Section, for relief of wounded viscera, 
such as bladder, spleen, intestines, kidney, liver 

or other organs 100 " 3,000 

Extirpation of tumors of minor importance .... 10 " 100 

Opening an abscess 5 " 25 

Paracentesis abdominis 15 " 100 

Dressing recent wounds, etc 5 " 25 

For each assistant in surgical operations 10 " 100 

Adjustment of fracture of long bones 50 " 500 



12 



Subsequent attendance at the ordinary rates, but 

each renewal of bandages or apparatus $ 5 " $15 

Reduction of dislocation 25 " 500 

Amputation of fingers or toes 25 " 50 

Amputation through tarsal or metatarsal bones . . 50 " 100 

Operation for sub-cutaneous tenotomy 25 " 100 

Operation for hare-lip or cleft palate 50 " 500 

Each subsequent dressing, at usual rate for dressing 
wounds. 

Operation for hemorrhoids 50 " 500 

Operation for fistula in ano -. . 50 " 500 

Operation for fissure of anus 10 " 50 

Each subsequent dressing, at usual rate for dressing 
wounds. 

Operation for hydrocele 25 " 50 

Operation for hydrocele, radical cure 50 " 300 

Reduction of strangulated hernia 50 " 300 

Special physical examination of chest .... 10 " 100 
Removing foreign bodies lodged in larynx or pesoph- 

agus 25 " 500 

Tracheotomy or intubation 50 " 500 

Major operations on the ear, as mastoid, etc. . . 50 " 500 

Major operations on nose and accessory sinuses . . 50 " 500 

Major operations on larynx, as removal of growth, 50 " 500 

Examination of eye by opthalmoscope 5 " 50 

Major operations on the eye 50 "1 ,000 

Minor operations on the eye, nose, throat, or ear, 5 " 50 

Administration of anaesthetic 10 " 100 

For letter of advice or written opinion 5 " 500 

All certificates of life insurance, insanity, etc. ... 5 " 25 

For attendance upon court, in civil cases, per day, 50 " 300 

For a postmortem examination, when ordered . . 10 " 100 
For a post mortem examination in a case of legal 

investigation 25 " 500 

For an examination involving a question of law in a 
case in which the ph ysician may be subpoenaed 
and in all cases in which the physician is re- 
quired to give a medical opinion before a Com- 
mittee of Congress 50 " 500 

Office instructions, $100 per annum ; $50 semi-annu- 
ally in advance. 



Sec. 2. The foregoing table contains the standard fees 
which shall be demanded ; they shall be increased, ac- 
cording to the judgment of the practitioner concerned, 



13 



in all cases of extraordinary detention or attendance ; 
also in proportion to the importance of the cases, of the 
responsibility attached to it, and to the services rendered, 
when these are extraordinary. They shall be dimin- 
ished at the discretion of the physician when he believes 
that the patient can not afford to pay the regular fees, 
and yet is able to make some compensation, but dimin- 
ishing the fees, except for motives of charity and benev- 
olence, is a violation of this regulation. 

Sec. 3. Medical officers connected with the stall's of the 
hospitals and dispensaries in the District of Columbia 
shall charge the usual fees for medical services rendered 
to persons who seek gratuitous services when they are 
able to pay. 

Sec. 4. Clergymen are not entitled to gratuitous ser- 
vices except when they are in indigent circumstances. 

Graduates of medicine are not entitled to gratuitous 
services unless they devote their entire time to the prac- 
tice of medicine or by reason of age or infirmity have 
retired from the regular practice of medicine, or unless 
such graduates of medicine, like other individuals, are 
in indigent circumstance-. 

Sec. 5. It is not designed by these regulations to pre- 
vent gratuitous services to those who are incapable of 
making remuneration without distressing themselves or 
families. 

Sec. 0. When a physician engaged to attend a case 
of obstetrics is absent, ami a second attends the patient, 
the latter may charge the full fee, but shall relinquish 
the patient to the first on his return ; and in no case 
shall the second continue to attend, except to render in- 
dispensable service during the continued absence or dis- 
ability of the first. 

Sec. 7. When one or more physicians are called in con- 
sultation the attending and consulting physician or pby- 



14 



sicians shall charge at least the ordinary fee for delivery 
or other services; but when the latter is not detained in 
attendance he shall only charge the usual fee for consul- 
tation. 

Sec. 8. It is recommended that the members of this 
Association present their accounts for professional serv- 
ices at the close of the attendance; and it shall be the 
duty of each member to obtain, if possible, a settlement 
from all his patients at least once in three months, viz: 
the first of January, the first of April, the first of July 
and the first of October. 

Sec. 9. No member of this Association shall make a 
contract, expressed or implied, to attend an individual or 
family by the year, or on any terms other than those 
authorized by these regulations. 

Article XIII. 
Hospitals and their Medical Staffs. 
Section 1. Every institution for medical charity shall 
require from every applicant for relief in its Hospital or 
Dispensary, a written certificate, to be obtained as here- 
inafter provided, that said applicant is unable to pay. 
Emergency cases are to be excepted from the operation 
of this rule. 

Sec. 2. Such certificate shall be obtained from Physi- 
cians to the Poor, the Associated Charities, or any reg- 
istered physician. 

Sec. 3. Sick and injured persons found upon the streets, 
in the stations or elsewhere, who require immediate treat- 
ment, shall be carried to the Emergency Hospital, or the 
nearest Hospital having an Emergency Service, or to their 
homes, if so directed by the patient or his friends. 

Sec. 4. Emergency patients shall not be detained 
longer in such Institutions than the necessity of the case 
imperatively demands, but shall be discharged from the 



15 



service and sent to their homes or to some public hospital 
as the patient may elect. 

Sec. 5. Members of this Association shall be entitled to 
the privilege of attending private patients occupying pri- 
vate rooms in any of the public hospitals of this city. 

Sec. 6. The members of the Medical Staff of Hospitals 
when attending medical or surgical cases in private pay- 
rooms shall insist upon proper payment for their services 
except in* the case of such patients as are clearly un- 
able to pay. 

Sec. 7. Whenever the Medical Staff of a Hospital or Dis- 
pensary, or any member thereof, is forced to resign, and 
when, after due hearing, this Association finds that the 
resignations were for unjust and insufficient cause, it 
shall be forbidden for any member of this Association to 
accept a position on the Staff of said Hospital or Dispen- 
sary. 

Sec. 8. Whenever one or more members of the Medical 
Staff of a Hospital or Dispensary are dismissed, and when, 
after due investigation, this Association finds that such 
dismissal was without just and sufficient cause, it shall 
be forbidden for any member of this Association to fill 
the vacancy created thereby. 

Sec. 9. Complaints made under Sees. 7 and 8 of this 
article shall be made in writing to the Standing Commit- 
tee, which after due consideration shall report its findings 
to the Association. 

Article XIV. 
Resignations. 

Resignations of membership or office shall be made in 
writing to the President, by whom they shall be presented 
to the Association, for its action, at the first succeeding 
meeting. 



16 



Article XV. 
Expulsions. 

Section 1. Any member may be expelled for violation 
of these regulations and ethics when, after due trial and 
conviction by the Standing Committee, such conviction 
and punishment is approved by a two-thirds vote of the 
Association, at an adjourned meeting, in accordance with 
Article VI, Sec. 4 (d). 

Sec. 2. In case any member shall neglect or refuse 
to pay an annual assessment for two years, his connec- 
tion with this Association shall thereupon cease. 

Article XVI. 
Seniority. 

Members shall rank in seniority according to the order 
in which they have affixed their names to the regulations 
and system of ethics. 

Article XVII. 
Obligation. 

Each physician elected to membership shall. sign the 
following obligation of this Association within thirty days 
thereafter, as provided in Article VII, Sec. 2, viz.: 

" I approve of the Regulations and System of Medical 
Ethics adopted by the Medical Association of the District 
of Columbia and agree, on my honor, to comply with the 
same." 

Article XVIII. 
Amendments. 

All propositions for repealing, altering, or amending 
these regulations shall be presented in writing at a 
stated meeting, and be acted upon at an adjourned 
meeting, which shall not be held for that purpose sooner 
than one month from the date of offering such proposi- 
tion, a copy of such amendments proposed being sent to 
each member with the notice of the meeting, and it shall 
require the concurrence of two-thirds of the members 
present for its adoption. 



17 



CODE OF MEDICAL ETHICS 

OF THE DUTIES OF PHYSICIANS TO THEIR PATIENTS, 
AND OF THE OBLIGATIONS OF PATIENTS 
TO THEIR PHYSICIANS. 



Aktici.e 1. — Dalit's of Physicians to their Patients. 

I I. A physician should not only be ever ready to obey the calls of 
the sick, but his mind ought also to be imbued with the greatness of 
his mission, and the responsibility he habitually incurs in its discharge. 
These obligations are the more deep and enduring, because there is no 
tribunal other than his- own conscience to adjudge penalties for careless- 
ness or neglect. Physicians should, therefore, minister to the sick with 
due impressions of the importance of their oihce ; reflecting that the 
ease, the health and the lives of those committed to their charge, depend 
on their skill, attention anil fidelity. They should study, also, in their 
deportment, so to unite tenderness with firmness, and condescension with 
authority, as to inspire the minds of their patients with gratitude, respect 
am 1 ci mhdence. 

% 2. Every case committed to the charge of a physician should be 
treated with attention, steadiness and humanity. Reasonable indul- 
gence should be granted to the mental imbecility and caprices of the 
sick. Secrecy and delicacy, when required by peculiar circumstances, 
should be strictly observed ; and the familiar and confidential inter- 
course to which physicians are admitted in their professional visits, 
should be used with discretion, and with the most scrupulous regard 
and fidelity and honor. The obligation of secrecy extends beyond the 
period of professional services ; none of the privacies of personal and 
domestic life, no infirmity of disposition or flaw of character observed 
during professional attendance should ever be divulged by the physi- 
cian except when he is imperatively required to do so. The force and 
necessity of this obligation are indeed so great, that professional men 
have, under certain circumstances, been protected in their observance 
of secrecy by courts of justice. 

# 3. Frequent visits to the sick are in general requisite, since they 
enable the physician to arrive at a more perfect know ledge of the dis- 
ease— to meet promptly every change which may occur, and also tend 
to preserve the confidence of the patient. But unnecessary visits are to 
lie avoided, as they give useless anxiety to the patient, tend to diminish 
the authority of the physician, and render him liable to be suspected of 
interested motives. 



is 



H- A physician should not be forward to make gloomy prognosti- 
cations, because they savor of empiricism by magnifying the import- 
ance of his services in the treatment or cure of the "disease. But he 
should not fail, on proper occasions, to give to the friends of the patient 
timely notice of danger when it really occurs ; and even to the patient 
himself, if absolutely necessary. This office, however, is so peculiarly 
alarming when executed by him, that it ought to be declined whenever 
it can be assigned to any other person of sufficient judgment and deli- 
cacy. For the physician should be the minister of hope and comfort to 
the sick, that, by such cordials to the drooping spirit, he may smooth 
the bed of death, revive expiring life, and counteract the depressing 
influence of those maladies which often disturb the tranquility of the 
most resigned in their last moments. The life of a sick person can be 
shortened not only by the acts, but also by the words or the manner 
of the physician. It is, therefore, a sacred duty to guard himself care- 
fully in this respect, and to avoid all things which have a tendency to 
discourage the patient and to depress his spirits. 

\ 5. A physician ou^ht not to abandon a patient because the case 
is deemed incurable ; for his attendance may continue to he highly use- 
ful to the patient, and comforting to the relatives around him, even in 
the last period of a fatal malady, by alleviating pain and other symp- 
toms, and by soothing mental anguish. To decline attendance, under 
such circumstances, would be sacrificing to fanciful delicacy and mis- 
taken liberality, that moral duty which is independent of, and superior 
to, all pecuniary consideration. 

\ 6. Consultations should be promoted in difficult or protracted 
cases, as they give rise to confidence, energy and more enlarged views 
in practice. 

\ 7. The opportunity which a physician not (infrequently enjoys of 
promoting and strengthening the good resolutions of his patients, suf- 
fering under the consequences of vicious conduct, ought never to be 
neglected. His counsels, or even remonstrances, will give satisfaction, 
not offense, if they be proffered with politeness, and evince a genuine 
love of virtue, accompanied by a sincere interest in the welfare of the 
person to whom they are addressed. 



Art, II. — Obligations of patients to their physicians. 

§1. The members of the medical profession, upon whom is enjoined 
the performance of so many important and arduous duties toward the 
community, and who are required to make so many sacrifices of com- 
fort, ease and health, for the welfare of those who avail themselves of 
their services, certainly have a right to expect and require that their 
patients should entertain a just sense of the duties which they owe to 
their medical attendants. 

§ 2. The first duty of a patient is to select as hie medical adviser 
one who has received a regular professional education. In no trade or 
occupation do mankind rely on the skill of an untaught artist : and in 
medicine, confessedly the most difficult and intricate of the sciences 
the world ought not to suppose that the knowledge is intuitive. 

\ 3. Patients should prefer a physician whose habits of life are reg- 
ular, and who is not devoted to company, pleasure, or to any pursuit 
incompatible with his professional obligations. A patient should, also 
confide the care of himself and family, as much as possible, to one' phy- 
sician ; for a medical man who has become acquainted with the peculi- 



19 



in itios of constitution, habits and predispositions of those he attends, 
is more likely to be successful in his treatment than one who does not 
possess that knowledge. 

A patient who has thus selected his physician should always apply 
for advice in what may appear to him trivial cases, for the most fatal 
results often supervene on the slightest accidents. It is of still more 
importance that he should apply for assistance in the forming stage of 
violent diseases ; it is to a neglect of this precept that medicine owes 
much of the uncertainty and imperfection with which it has been 
re] m ached. 

\ 4. Patients should faithfully and unreservedly communicate to 
their physician the supposed cause of their disease. This is the more 
important, as many diseases of a mental origin simulate those depend- 
ing on external causes and yet are only to be cured by ministering to 
the mind diseased. A patient should never be afraid of thus making 
his physician his friend and adviser; he should always bear in mind 
that a medical man is under the strongest obligations of secrecy. Even 
the female sex should never allow feelings of shame or delicacy to pre- 
vent their disclosing the seat, symptoms and causes of complaints pecu- 
liar to them. However commendable a modest reserve may be in the 
common occurrences of life, its strict observance in medicine is often 
attended with the most serious consequences, and a patient may sink 
under a painful and loathsome disease, which might have been readily 
prevented had timely intimation been given to the physician. 

I 5. A patient should never weary his physician with a tedious 
detail of events or matters not appertaining to his disease. Even as 
relates to his actual symptoms, he will convey much more real informa- 
tion by giving clear answers to interrogatories, than by the most minute 
account of hisown framing. Neither should he obtrude upon his phy- 
sician the details of his business nor the history of his family concerns. 

<>. The obedience of a patient to the prescriptions of his physician 
should be prompt and implicit. He should never permit his own crude 
opinions as to their fitness to influence his attention to them. A failure 
in one particular may render an otherwise judicious treatment danger- 
ous, and even fatal. "This remark is equally applicable to diet, drink 
and exercise. As patients become convalescent they are very apt to 
suppose that the rules prescribed for them may be disregarded, and the 
consequence, but too often, is a relapse. Patients should never allow 
themselves to be persuaded to take any medicine whatever that may 
be recommended to them by the self-constituted doctors and doctor- 
esses who are so frequently met with, and who pretend to possess infal- 
lible remedies for the cure of every disease. However simple some of 
their prescriptions may appear to be, it often happens that they are 
productive of much mischief, and in all cases they are injurious, by con- 
travening the plan of treatment adopted by the physician. 

I 7. A patient should, if possible, avoid even the friendly visits of a 
physician who is not attending him— and when he does receive then:, 
he should never converse on the subject of his disease, as an observation 
may be made, without any intention of interference, which may destroy 
his confidence in the course he is pursuing, and induce him to neglect 
the directions prescribed to him. A patient should never send for a 
consulting physician wit hout the express consent of his own medical 
attendant. It is of great importance that physicians should act in con- 
cert ■ for although their modes of treatment may be attended with 
equal success when applied singly, yet conjointly they are very likely 
to be productive of disastrous results. , . . . . 

I 8. When a patient wishes to dismiss his physician, justice and 



20 



common courtesy require that he should declare his reasons for so 
doing. 

§ 9. Patients should always, when practicable, send for their physi- 
cian in the morning, before his usual hour of going out ; for, by being 
early aware of the visits he has to pay during the day, the physician 
is able to apportion his time in such a manner as to prevent an inter- 
ference of engagements. Patients should also avoid calling on their 
medical adviser unnecessarily during the hours devoted to meals or sleep. 
They should always be in readiness to receive the visits of their physi- 
cian, as the detention of a few minutes is often of serious inconvenience 
to him. 

\ 10. A patient should after his recovery, entertain a just and endear- 
ing sense of the value of the services rendered him by his physician; 
for these are of such a character, that no mere pecuniary acknowledg- 
ment can repay or cancel them. 

OF THE DUTIES OF PHYSICIANS TO EACH OTHER, AND TO 
THE PROFESSION AT LARGE. 

Article l.— Dulicx for the Support of Prqfessirmal Character. 

§ 1. Every individual on entering the profession, as he becomes 
thereby entitled to all its privileges and immunities, incurs an obliga- 
tion to exert his best abilities to maintain its dignity and honor, to exalt 
its standing, and to extend the bounds of its usefulness. He should, 
therefore, observe strictly such laws as are instituted for the govern- 
ment of its members ; should avoid all contumelious and sarcastic 
remarks relative to the faculty as a body; and while, by unwearied 
diligence, he resorts to every honorable means of enriching the science, 
he should entertain a due respect for his seniors, who have, by their 
labors, brought it to the elevated condition in which he finds it. 

$ 2. It is not in accord with the interests of the public or the honor 
of the profession that any physician or medical teacher should examine 
or sign diplomas or certificates of proficiency for. or otherwise he spe- 
cially concerned with, the graduation of persons whom they have good 
reason to believe intend to suppi irl and practice any exclusive and irreg- 
ular system of medicine. 

$ 3. There is no profession from the members of which geater purity 
of character and a higher standard < >f moral excellence are required, than 
the medical ; and to attain such eminence is a duty every physician owes 
alike to his profession and to his patients. It is due to the latter, as without 
it he can not command their respect and confidence, and to both, because 
no scientific attainments can compensate for the want of correct moral 
principles. It is also incumbent upon the faculty to he temperate in all 
things, for the practice of physics requires the unremitting exercise i if a 
clear and vigorous understanding; and on emergencies, for which no 
professional man should be unprepared, a steady hand, an acute eye 
and an unclouded head maybe essential to the well-being, and even to 
the life, of a fellow-creature. 

\ 4. It is derogatory to the dignity of the profession to resort to pub- 
lic advertisements, or private cards, or handbills, inviting the attention 
of individuals affected with particular diseases— publicly offering advice 
and medicine to the poor gratis, or promising radical cures ; or to pub- 



21 



lish cases and operations in the daily prints, or suffer such publications 
to be made ; to invite laymen to be present at operations , to boast of 
cures and remedies; to adduce certificates of skill and success, or to 
perforin any other similar acts. These are the ordinary practices of 
empirics, and are highly reprehensible in a regular physician. 

* 5- Equally derogatory to professional character is it for a physician 
to hold a patent for any surgical instrument or medicine, or to dispense 
a secret nostrum, whether it he the composition or exclusive property of 
himself or of others. For, if such nostrum be of real efficacy, any con- 
cealment regarding it is inconsistent with beneficence and professional 
liberality ; and if mystery alone give it value and importance, such craft 
implies either disgraceful ignorance or fraudulent avarice. It is also 
reprehensible for physicians to give certificates attesting the efficacy of 
patent or secret medicines, or in any way to promote the use of them. 

Art. II. — Professional services of physicians to each other. 

% 1. All practitioners of medicine, their wives, and their children 
while under the paternal care, are entitled to the gratuitous services of 
any one or more of the faculty residing near them, whose assistance 
may be desired. A physician afflicted with disease is usually an incom- 
petent judge of his own case; and the natural anxiety and solicitude 
which he experiences at the sickness of a wife, a child, or anyone who, 
by the ties of consanguinity, is rendered peculiarly dear to him, tend to 
obscure his judgment and produce timidity and irresolution in his prac- 
tice. Under such circumstances, medical men are peculiarly dependent 
upon each other, and kind offices and professional aid should always 
be cheerfully and gratuitously afforded. Visits ought not, however, to 
be obtruded officiously ; as such unasked civility may give rise to em- 
barrassment, or interfere with that choice on which confidence depends. 
But if a distant member of the faculty, whose circumstances are afflu- 
ent, request attendance, and an honorarium be offered, it should not be 
declined ; for no pecuniary obligation ought to be imposed which the 
party receiving it would wish not to incur. 

A UT. III. — Of the duties of physicians as respects vicarious offices. 

Z 1. The affairs of life, the pursuit of health, and the various acci- 
dents and contingencies to which a medical man is peculiarly exposed, 
sometimes require him temporarily to withdraw from his duties to his 
patients, and to request some of his professional brethren to officiate for 
him. Compliance wi:h this request is an act of courtesy which should 
always be performed with the utmost consideration for the interest and 
character of the family physician, and when exercised for a short per- 
iod all the pecuniary obligations for such services should he awarded 
to him. But if a member of the profession neglect his business in quest 
of pleasure and amusement, he can not be considered as entitled to the 
advantages of the frequent ami long continued exercise of this fraternal 
courtesy, without awarding to the physician who officiates the fees 
arising from the discharge of his professional duties. 

In obstetrical and important surgical eases, which give rise to unus- 
ual fatigue, anxiety and responsibility, it is just that the fees accruing 
therefrom should be awarded to the physician who officiates. 

Art. IV. — Of the duties of plnjsicians in regard to consultations. 
§ 1. A regular medical education furnishes the only presumptive 



22 



evidence of professional abilities and acquirements, and ought to be 
the only acknowledged right of an* individual to the exercise and hon- 
ors of his profession. Nevertheless, as in consultations the good of the 
patient is the sole object in view, and this is often dependent on per- 
sonal confidence, no intelligent regular practitioner, who has a license 
to practice from some medical board of known and acknowledged 
respectability, recognized by the Association, and who is in good moral 
and professional standing in the place in which he resides, should he 
fastidiously excluded from fellowship, or his aid refused in consulta- 
tion, when it is requested by the patient. But no one can be considered 
as a regular practitioner or a fit associate in consultation whose practice 
is based on an exclusive dogma, to the rejection of the accumulated 
experience of the profession, and of the aids actually furnished by anat- 
omy, physiology, pathology and organic chemistry. 

g 2. In consultations no rivalship or jealousy should be indulged ; 
candor, probity and all due respect should be exercised toward the 
physician having charge of the case. 

#3. In consultations the attending physician should be the first to 
propose the necessary questions to the sick ; after which the consulting 
physician should have the opportunity to make such further inquiries 
of the patient as may be necessary to satisfy him of the true character 
of the case. Both physicians should then retire to a private place for 
deliberation ; and the one first in attendance should communicate the 
directions agreed upon to the patient or his friends, as well as any opin- 
ion which it may be thought proper to express. But no statement or 
discussion of it should take place before the patient or his friends, 
except in the presence of all the faculty attending, and by their com- 
mon consent ; and no opinions or prognostications should be delivered 
which are not the result of previous deliberation and concurrence. 

\ 4. In consultations, the physician in attendance should deliver 
his opinion first; and when there are several consulting, they should 
deliver their opinions in the order in which they have been called. No 
decision, however, should restrain the attending physician from mak- 
ing such variations in the mode of treatment as any subsequent unex- 
pected change in the character of the case may demand. But such 
variation, and the reasons for it, ought to be carefully detailed at the 
next meeting in consultation. The same privilege belongs also to the 
consulting physician if he is sent for in an emergency, when the regu- 
lar attendant is out of the way, and similar explanations must be made 
by him at the next consultation. 

\ 5. .The utmost punctuality should be observed in the visits of physi- 
cians when they are to hold consultations together, and this is generally 
practicable, for society has been considerate "enough to allow the plea of 
a professional engagement to take precedence of all others, and to be an 
ample reason for t he relinquishment of any present occupation. But as 
professional engagements may sometimes interfere and delay one of the 
parties, the physician who firsl arrives should wait for his associate a 
reasonable period, after w Inch the consultation should be considered as 
postponed to a new appointment. If it be the attending physician who 
is present, he will, of course, see the patient and prescribe ; 'but if it be 
the consulting one, he should retire, except in case of emergency or 
when he has been called from a considerable distance. i n w inch latter 
case he may examine the patient, and give his opinion in ivriting and 
under seal, to be delivered to his associate. 

\ 6. In consultations, theoretical discussions should be avoided 
as occasioning perplexity and loss of time. For there may be much' 
diversity of opinion concerning speculative points, with perfect agree- 



23 



ment in those modes of practice which are founded, not on hypothesis, 
but on experience and observation. 

\ 7. All discussions in consultation should beheld as secret and con- 
fidential. Neither by words nor manner should any of the parties to a 
consultation assert or insinuate that any part of the treatment pursued 
did not receive his assent. The responsibility must he equally divided 
between the medical attendants— they must equally share the credit of 
success as well as the blame of failure. 

\ S. Should an irreconcilable diversity of opinion occur when several 
physicians are called upon to consult together, the opinion of the ma- 
jority should be considered as decisive ; but if the numbers be equal on 
each side, then the decision should rest with the attending physician. 
It may, moreover, sometimes happen that two physicians can not agree 
in their views of the nature of a case and the treatment to be pursued. 
This is a circumstance much to be deplored, and should always be 
avoided, if possible, by mutual concessions, as far as they can be justi- 
fied by a conscientious regard for the dictates of judgment. But in the 
event of its occurrence, a third physician should, if practicable, be called 
to act as umpire; and, if circumstances prevent the adoption of this 
course, it must be left to the patient to select the physician in whom he 
is most willing to confide. But, as every physician relies upon the rec- 
titude of his judgment, he should, when left in the minority, politely 
and consistently retire from any further deliberation in the consultation, 
or participation in the management of the case. 

£ 9. As circumstances sometimes occur to render a special consultation 
desirable, when the continued attendance of two physicians might be 
objectionable to the patient, the member of the faculty whose assistance 
is required in such cases should sedulously guard against all future un- 
solicited attendance. As such consultations require an extraordinary 
portion of both time and attention, at least a double honorarium may 
be reasonably expected. 

\ 10. A physician who is called upon to consult, should observe the 
most honorable and scrupulous regard for the character and standing of 
the practitioner in attendance; the practice of the latter, if necessary, 
should be justified as far as can be, consistently with a conscientious 
regard for truth, and no hint or insinuation should be thrown out 
which could impair the confidence reposed in him, or affect his reputa- 
tion. The consulting phvsician should also carefully refrain from any 
of those extraordinary attentions or assiduities which are toooften prac- 
ticed by the dishonest for the base purpose of gaining applause, or in- 
gratiating themselves into the favor of families and individuals. 



^ KT v.— Duties of physicians in cases of interference. 

\ 1. Medicine is a liberal profession, and those admitted into its 
ranks should found their expectations of practice upon the extent of 
their qualifications, not on intrigue or artifice. < 

g2 A physician, in his intercourse with a patient under the care ot 
another practitioner, should observe the strictest caution and reserve. 
No meddling inquiries should be made— no disingenuous hints given 
relative to the nature and treatment of his disorder; nor any course of 
conduct pursued that may directly or indirectly tend to dimmish the 
trust reposed in the physician employed. 

\ 3 The same circumspection and reserve should be observed when, 
from motives of business or friendship, a physician is prompted to visit 
an individual who is under the direction of another practitioner. 



24 



Indeed, such visits should be avoided, except under peculiar circum- 
stances; and when they are made, no particular inquiries should be 
instituted relative to the nature of the disease, or the remedies em- 
ployed, but the topics of conversation should be as foreign to the case 
as circumstances will admit. 

# 4. A physician ought not to take charge of or prescribe for a 
patient who has recently been under the care of another member of the 
faculty in the same illness, except in cases of sudden emergency, or in 
consultation with the physician previously in attendance, or when the 
lat ter has relinquished the case, or been regularly notified that his ser- 
vices are no lunger desired. Under such circumstances, no unjust and 
illiberal insinuations should be thrown out in relation to the conduct 
or practice previously pursued, which should be justified as far as can- 
dor and regard for truth and probity will permit ; for it often happens 
that patients become dissatisfied when they do not experience imme- 
diate relief, and, as many diseases are naturally protracted, the want 
of success, in the first stage of treatment, affords no evidence of a lack 
of professional knowledge and skill. 

I 5. When a physician is called to an urgent case, because the fam- 
ily attendant is not at hand, he ought, unless his assistance in consulta- 
tion be desired, to resign the care of the patient to the latter immedi- 
ately on his arrival. 

i 6. It often happens in ease of sudden illness, or of recent accidents 
and injuries, owing to the alarm and anxiety of friends, that a number 
of physicians are simultaneously sent for. Under these circumstances, 
courtesy should assign the patient to the first who arrives, who should 
select from those present any additional assistance that he may deem 
necessary. In all such cases, however, the practitioner who officiates 
should request the family physician, if there be one, to be called, and, 
unless his further attendance be requested, should resign the case to 
the latter on his arrival. 

\ 7. When a physician is called to the patient of another practitioner, 
in consequence of the sickness or absence of the latter, he ought on the 
return or recovery of the regular attendant and with the consent of the 
patient, to surrender the case. 

(The expression, " patient of another practitioner," is understood to 
mean a patient who may have been under the charge of another prac- 
titioner at the time of the attack of sickness, or departure from home of 
the latter, or who may have called for his attendance during his absence 
or sickness, or in any other manner given it to be understood that he 
regarded the said physician as his regular medical attendant. ) 

§8. A physician, when visiting a sick person in the country, may 
be desired to see a neighboring patient who is under the regular direc- 
tion of another physician, in consequence of some sudden change or 
aggravation of symptoms. The conduct to be pursued on such an oc- 
casion is to give advice adapted to present circumstances ; to interfere 
no further than is absolutely necessary with the general plan of treat- 
ment ; to assume no future direction unless it lie expressly desired; 
and, in this last case, to request an immediate consultation with the 
practitioner previously employed. 

\ 9. A wealthy physician should not give advice gratis to the affluent ■ 
because his doing so is an injury to his professional brethren. The 
office of a physician can never be supported as an exclusively beneficent 
one; and it is defrauding, in some degree, the common funds for its 
support, when fees are dispensed with which might justly be claimed 

I lo. When a physician who has been engaged to attend a ease of 
midwifery is absent, another is sent for ; if delivery is accomplished 



25 



during the attendance of the latter, he is entitled to fee, but should re- 
sign the patient to the practitioner first engaged. 

Art. VI. — Of differences between physicians. 

1 1. Diversity of opinion and opposition of interest may, in the 
medical as in other professions, sometimes occasion controversy and 
even contention. Whenever such eases unfortunately occur and can 
not he immediately terminated, they shonld be referred to the arbitra- 
tion of a sufficient number of physicians or a court*medicctl. 

2 2. As peculiar reserve must he maintained by physicians toward 
the public, in regard to professional matters, and as there exist numer- 
ous points in medical ethics and etiquette through which the feelings 
of medical men may be painfully assailed in then intercourse with each 
other, and which can not be understood or appreciated by general 
society, neither the subject-matter of such differences nor the adjudica- 
tion of the arbitrators should be made public, as publicity in a case of 
this nature may be personally injurious to the individuals concerned, 
and can hardly fail to bring discredit on the faculty. 

Art. VII. — Of pecuniary acknowledgm< nts. 

Some general rules should be adopted by the faculty, in every town 
or district, relative to pecuniary acknowledgments from their patients ; 
and it should be deemed a point of honor to adhere to these rules with 
as much uniformity as varying circumstances will admit. 



OF THE DUTIES OF THE PROFESSION TO THE PUBLIC. 
AND OF THE OBLIGATIONS OF THE PUBLIC 
TO THE PROFESSION. 

Article I. — Duties of the Profession to the Public. 

? 1. As good citizens, it is the duty of physicians to be ever vigilant 
for the welfare of the community, and to hear their part in sustaining 
its institutions and burdens ; they should also be ever read}' to give 
counsel to the public in relation to matters especially appertaining to 
their profession, as on subjects of medical police, public hygiene and 
legal medicine. It is their province to enlighten the public in regard to 
quarantine regulations; the location, arrangement and dietaries of hos- 
pitals, asylums, schools, prisons, and similar institutions; in relation to 
the medical police of towns, as drainage, ventilation, etc.; and in re- 
gard to measures for the prevention of epidemic and contagious dis- 
eases ; and when pestilence prevails, if is their duty to lace the danger, 
and to continue their labors for the alleviation of the suffering, even at 
the jeopardy of their own lives. 

$ 2. Medical men should also he always ready, when called on by the 
legally constituted authorities, to enlighten coroners' inquests and 
courts' of justice on subjects strictly medical— such as involve questions 
relating to sanity, legitimacy, murder by poison or other violent means, 
and in regard to the various other subjects embraced in the science of 



<2C, 



Medical Jurisprudence. But in these cases, and especially where they 
an ' required to make a post-mortem examination, it is "just, in con- 
sequence of the time, labor and skill required, and the responsibility 
and risk they incur, that the public should award thorn a proper 
honorarium. 

I 3. There is no profession by the members of which eleemosynary 
services are more liberally dispensed than the medical, but justice re- 
quires that some limits shuld be placed to the performance of such good 
offices. Poverty, professional brotherhood, and certain of the public 
duties referred to in the first section of tins article, should always he 
recognized as presenting valid claims for gratuitous services ; but neither 
institul ions endowed by the public or by rich individuals, societies for 
mutual benefit, for the insurance of lives or for analogous purposes, nor 
any profession or occupation, can be admitted to possess such privilege. 
Nor can it be justly expected of physicians to furnish certificates of 
inability to serve on juries, to perform militia duty, or to testify to the 
state of health of persons wishing to insure their lives, obtain pensions, 
or the like, without a pecuniary acknowledgment. But to individuals 
in indigent circumstances, such professional services should always be 
cheerfully and freely accorded. 

\ 4. It is the duty of physicians, who are frequent witnesses of the 
enormities committed by quackery, and the injury to health and even 
destruction of life caused by the use of quack medicines, to enlighten 
the public on these subjects, to expose the injuries sustained by the 
unwary from the devices and pretensions of artful empirics and impos- 
tors. Physicians ought to use all the influence which they may possess, 
as professors in Colleges of Pharmacy, and by exercising their option in 
regard to the shops to which their" prescriptions shall be sent, to dis- 
courage druggists and apothecaries from vending quack or secret medi- 
cines, or from being in any way engaged in their manufacture and sale. 

Art. II. — Obligations of (he public to physicians. 

\ 1. The benefits accruing to the public, directly and indirectly, from 
the active and unwearied beneficence of the profession, are so numer- 
ous and important that physicians are justly entitled to the utmost con- 
sideration and respect from the community. The public ought like- 
wise to entertain a just appreciation of medical qualifications : to make 
a proper discrimination between true science and the assumptions of 
ignorance and empiricism ; to afford every encouragement and facility 
for the acquisition of medical education— and no longer to allow the 
statute books to exhibit the anomaly of exacting knowledge from phy- 
sicians, under a liability to heavy penalties, and of making them ob- 
noxious to punishment for resorting to the only means of obtaining it 



EXPLANATORY DECLARATIONS. 

Whereas. Persistent misrepresentations have been and still are being made con- 
cerning certain provisions of the Code of Ethics of this Association, by which many 
in the community, and some in the ranks of the profession, are led to believe those 
provisions exclude persons from professional recognition simply because of differ 
ences of opinions or doctrines ; therefore, 

1. Resolved, That clause first, of Art. IV, in the National Code of Medical Ethic 
is not to be interpreted as excluding from professional fellowship, on the ground of 
differences in doctrine or belief, those who in other respects are entitled to be mem 



27 



bers of the regular medical profession. Neither is there any other article or clause 
of the said Code of Ethics that interferes with the exercise of the most perfect lib- 
erty of individual opinion and practice. 

2. Resolved, That it constitutes a voluntary disconnection or withdrawal from the 
medical profession proper, to assume a name indicating' to the public a sectarian, or 
exclusive system of practice, or to belong to an association or party antagonistic to 
the general medical profession. 

3. Resolved, That there is no provision in the National Code of Medical Ethics in 
any wise inconsistent w ith the broadest dictates of humanity, and that the article of 
the Code which relates to consultations can not be correctly interpreted as interdict- 
ing, under any circumstances, the rendering of professional services whenever there 
is a pressing or immediate need of them. On the contrary, to meet the emergencies 
occasioned by disease or accident, and to give a helping hand to the distressed with- 
out unnecessary delay, is a duty fully enjoined on every member of the profession, 
both by the letter and spirit of the entire Code. 

But no such emergencies or circumstances can make it necessary or 
proper to enter into formal professional consultations with those who 
have voluntarily disconnected themselves from the regular medical 
profession, in the manner indicated by the preceding resolution. 

N. S. Davis of Chicago, 
A. Y. P. Garnett of Washington, 
H. F. Campbell of Augusta, Ga., 
Austin Flint of New York, 
J. B. Mukdock of Pittsburg. 



03 



o 



o 

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